MEDICARE: CARLOS ORTIZ CM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1548383185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS ORTIZ CM

Provider Business Mailing Address
First Line	:	830 E OAKLAND PARK BLVD
Second Line	:	SUITE 121
City	:	OAKLAND PARK
State	:	FL
Zip	:	33334-2761
Country	:	US
Telephone Number	:	954-567-7141
Fax Number	:	954-703-2029

Provider Business Practice Location Address
First Line	:	830 E OAKLAND PARK BLVD
Second Line	:	SUITE 121
City	:	OAKLAND PARK
State	:	FL
Zip	:	33334-2761
Country	:	US
Telephone Number	:	954-567-7141
Fax Number	:	954-703-2029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/08/2007

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Directions to “ CARLOS ORTIZ CM” Practice Location

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